Provider Demographics
NPI:1982376307
Name:RUCKER, ROBYN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ROBYN
Middle Name:
Last Name:RUCKER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30800 NORTHWESTERN HWY
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2569
Mailing Address - Country:US
Mailing Address - Phone:248-298-9198
Mailing Address - Fax:
Practice Address - Street 1:30800 NORTHWESTERN HWY
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2569
Practice Address - Country:US
Practice Address - Phone:248-298-9198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-04
Last Update Date:2021-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68011092351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical